Status of Medicaid Retroactive Benefits in Florida

There has been some confusion regarding whether it is still possible to request Medicaid retroactive benefits. Unfortunately, it is still impossible to request Medicaid retroactive benefits.

As a reminder of what has happened so far – up until February 1, 2019, a non-pregnant adult Medicaid applicant could request and be granted retroactive Medicaid eligibility and coverage for up to three months prior to the month of application. In other words, if an applicant applies for Medicaid in April, the applicant can request and receive Medicaid coverage for the months of January, February, and March, if the applicant would have met all the eligibility requirements during January, February, and March. In 2018, the Florida Legislature and the Florida Governor Rick Scott passed the 2018-2019 Florida budget, which mandated that the Florida Agency for Health Care Administration (AHCA) apply for federal approval to “eliminat[e] the Medicaid retroactive eligibility period for non-pregnant adults.” In March 2018, AHCA prepared an amendment to the State of Florida’s current Managed Medical Assistance (MMA) Waiver Medicaid plan, which would eliminate retroactive Medicaid coverage for non-pregnant adults. On November 30, 2018, the federal Centers for Medicare and Medicaid Services (CMS) granted the amendment and approved the termination of retroactive eligibility effective February 1, 2019. Thus, applications filed on or after February 1, 2019 could not request retroactive Medicaid eligibility.

            During this past legislative session, Senate Bill 2502, was passed and signed into law by Governor Ron DeSantis. This bill stated that effective July 1, 2019, for nonpregnant adults, payments for Medicaid services can only be made retroactive to the first day of the month in which the application for Medicaid is filed. In other words, the applicant can still not request Medicaid retroactive Medicaid. 

The bill also requires AHCA to consult with stakeholders such as the Department of Children and Families (DCF), the Florida Hospital Association, the Safety Net Hospital Alliance of Florida, the Florida Health Care Association, and LeadingAge Florida to submit a report to the Governor and the President of the Senate and the Speaker of the House of Representatives regarding the impact of no Medicaid retroactive benefits on Medicaid beneficiaries and Medicaid providers. The report must include information on the total number who applied for Medicaid at a nursing home or a hospital, and out of that number, the number of approvals and denials and the reasons for denials; the impact of medical debt on people who did not apply for Medicaid in the same month that they were admitted to a hospital or nursing home; and recommendations on how to improve outreach and Medicaid coverage for nonpregnant adults before they have an event that would require hospital or nursing home care.

You may wonder why is retroactive Medicaid important or necessary? Some people may need to stay in a nursing home long term or for the foreseeable future. And these people look to Medicaid to help pay the $7000 to $15,000 monthly bill. And, they may be unable to apply for Medicaid in the same month they were admitted. It may take more than 30 days to gather information about the applicant’s assets, income, and previous gifting/transfers to verify Medicaid eligibility. Sometimes, it may take more than 30 days solely for a financial institution to review a Power of Attorney document and comply with a request for information. If the Medicaid applicant is incompetent or the Power of Attorney document is insufficient for Medicaid planning, it may be necessary for someone to petition the court for a Guardianship over the Medicaid applicant, which may take up to several weeks.

Another example would be the previously healthy uninsured young person who is in a catastrophic accident and in a hospital for several weeks. During this crisis, the applicant may not be physically or mentally able to compile the necessary information for a Medicaid applicant. Also, the applicant’s family and caregivers may be more concerned with the applicant’s care and ultimately survival, than on how to pay the medical providers. The applicant and their family may be unable to pay for the large hospital bills for the medical care they received in the months before the month of application.

Now that Medicaid retroactive coverage is gone, it is more important than ever to apply for Medicaid as soon as practicable for someone who will need to be in the nursing home long term once that person is financial eligible. Once the person is admitted into the nursing home, even if the person is financially eligible for Medicaid, there is no way to receive Medicaid benefits for a month before the month of application. That means that people who are at risk of needing long term care in a facility and his or her spouse should have their estate planning documents prepared and they should start working on gathering the financial, medical, and personal information and documentation that are needed for a Medicaid application beforehand. This means possibly keeping all the financial statements in an organized fashion; obtaining copies of birth certificates, driver’s licenses, ID cards, marriage certificates, military discharge records, Medicare cards, Medicare supplement cards, health insurance cards, Medicare Part D prescription cards; verifying that they have copies of all life insurance policies and annuity contracts, real estate deeds, vehicle titles, pre-paid burial policies, cemetery plot deeds, etc. Also, people should keep the annual statement that they receive from Social Security and their pensions. In a crisis, it may sometimes take up to 6 to 8 weeks to receive these documents and the applicant may have to delay their application in the interim.

If you would like assistance in applying for Medicaid or have questions about Medicaid, please contact Osterhout & McKinney.

Leave a Comment

Scroll to Top